Support & Treatment FAQ

Q1: What Exactly Is Breast Cancer?

Abnormal growth of cells at an uncontrolled rate forming irregular patterns
Cancer cells reproduce at a much higher rate of growth than normal cells
Cancer cells not only multiply in the breast but also spread to other parts of the body (metastasis)

Q2: Can I prevent breast cancer?

Presently there is no known way to prevent breast cancer. We can however be proactive in certain areas. Limiting alcohol intake seems to be a positive step according to research studies.
Low fat diet is always advised, along with lots of exercise.
It is recommended by the Canadian Breast Cancer Foundation to follow a triad approach - perform monthly breast self-examination, yearly clinical exam by a health care provider and mammography from ages 50-69 every two years or where age or risk appropriate. None of these screening methods are foolproof, however when combined they form the best early detection tools available.

Q3: What are my hereditary risks for breast cancer?

The risk for breast cancer is different for each individual. It depends on which relatives have had breast cancer and the age at which they were diagnosed. BRCA1 and BRCA2 are genes that are responsible for inherited breast cancer and together they account for approximately 10% of all breast cancers. The following chart from the Canadian Cancer Society offers Breast Cancer Risk Estimates:

Q4: Where can I learn breast self-examination?

Breast self examination techniques are offered as part of our Breast Health Workshop, which are available through our centre free of charge every month. These workshops take place at Breast Cancer Support Services, 695 Brant St. Burlington, ON L7R 2H4. Please call the centre for more details (905)634-2333.

Q6: I found a lump. What now?

Finding a breast lump or a change in your breast can be stressful and overwhelming. It is natural to feel scared, sad, and/or uncertain. As well as getting medical attention you may also feel the need for support from your family, friends and our group.

REMEMBER: 80% of all breast lumps are not cancer.

You are not alone. You have time to make choices. And you can help yourself:

o Mark the spot on your breast where you found the lump before visiting the doctor
o Remember that often there is no pain associated with a breast lump
DON’T WAIT - ACT NOW! Make sure your lump is checked by a doctor
o Make a list of your questions and concerns so you will remember them
o Take someone with you to your appointment to be a comfort and a recorder a
o Seek more information if or when you need it from medical sources
o Ask about special tests
For specific information about tests you can expect, check out our article about Finding A Lump.

Q7: What are some breast cancer myths?

1. Breast cancer only affects women.
FALSE -- Men can also get breast cancer. However, men make up just over 1% of all breast cancer cases.

2. FALSE -- Breast Self-Examinations (BSE) are not necessary to perform if you have a physical and/or mammogram every year.

3. Breast implants would interfere with testing and treatment of breast lumps and/or breast cancer.
FALSE -- Breast implants do not rule out availability of testing and treatments. Canadian Breast Cancer Initiative 1998

4. One in 9 Canadian women can expect to develop breast cancer during her lifetime.
TRUE -- The chances of developing breast cancer is 1in 9; whereas the chances of dying of breast cancer is 1 in 24.9. Canadian Cancer Statistics 1999.

5. All lumps found in the breast could be cancerous.
WRONG -- Lumps in breast are common and most are not due to cancer. Canadian Breast Cancer Initiative 1998

6. Adopting healthy lifestyles such as a low-fat diet may decrease your risk of breast cancer.
TRUE -- Restrict the fat intake in your diet and increase your fibre intake by eating plenty of whole-grain cereals, fruit and vegetables; Enjoy alcohol only in moderation; Keep your body fat down with a balanced diet and regular exercise; If you have children, breastfeed - the longer the better. The Breast Book : Dr. M. Stoppard.

7. Breast Self-Examination should be performed every month.
TRUE -- Breast self-exams are best done just after one’s menstrual menstrual cycle is over, when hormonal stimulation of breast tissue is least apparent. Women’s Bodies, Women’s Wisdom.

8. There are an estimated 300 breast cancer support and advocacy groups across Canada.
TRUE -- There are an estimated 300 breast cancer support and advocacy groups across Canada. Network News/Spring 1999

9. There will be an estimated 18,700 new cases of breast cancer in women for 1999 in Canada; 7,400 of these cases will be in Ontario.
TRUE -- Canadian Cancer Statistics 1999

10. Breast cancer is only found in the form of a lump in the breast.
FALSE -- Not all breast cancer is found in the form of a lump. There is also dimpling around the nipple, secretion from the nipple and changes in skin texture.

Q8: What questions should I ask my doctor to understand my treatment?

An open dialogue between you and your doctor will build a solid foundation for good health care.
Here are some questions you might want to ask your doctor:

· How much experience have you had treating patients like me?
· How do I contact you in an emergency?
· Who takes care of me when you are not available?
· Can you give me a specific diagnosis?
· When will test results be available?
· How will you notify me of the results?
· Can I get a copy of the results?

· Why do you recommend this particular test, treatment, procedure or medication?
· What are the alternatives?
· What are the benefits, and risk, of each option, including doing nothing?
· What should I expect to happen when I have this particular treatment or procedure?
· How long will it take?
· How much pain or impairment is usually involved? For how long?
· When should I call back about my condition or symptoms?
· When can I expect to see improvement?
· Will I have special needs, such as assistance at home, medication, or a special diet?
· Should I see a specialist? Will you continue to care for me, too? How will all my doctors communicate with each other about my care?
· How often and when should I take my medication? Are there side effects? Can I take other medications, or alcohol, at the same time? What if I forget to take it on schedule?
· Do you have an up-to-date record of the medications I currently take, and any allergies or problems I have with medications?
· Can you give me information about these treatments, procedures, and medications in writing to take home with me?
· Will you (or your staff) be available to answer my questions by telephone?

Ask your doctor to explain anything you don’t understand. Feel free to write down questions before the visit and take notes during your visit. Don’t expect to remember everything you want to ask your doctor during the visit, it’s normal to think of questions afterwards.

Keep in touch with your doctor to make sure all your questions are answered. This will establish an open and comfortable relationship with your doctor, the foundations of good health care.

Q9: Will I lose my hair with chemotherapy?

Hair loss occurs with many but not all types of chemotherapy. When looking at chemotherapy drugs, some drugs never cause hair loss but some always do. Hair loss frequently happens 3-4 weeks after the first treatment. The hair loss may be gradual or all at once, but keep in mind that hair loss due to chemotherapy is always temporary and will grow back.

Q10: Will chemo drugs make me sick?

Nausea and vomiting are common side effects of chemotherapy. Medications are available that reduce or eliminate the effects. Other effects may include body weakness, body ache, bloating, weight gain, changes in complexion, night sweats, changes in taste or smell. These side effects will subside after treatment is finished.

Q11: How long will my chemotherapy treatments last?

Just as each person’s body is different, each chemotherapy treatment regimen is different and is tailored to each patient’s needs. Treatments are usually a few weeks in duration.

Q12: Are there any lasting side effects to chemo treatments?

Generally, most of the conditions and problems that occur during or after chemotherapy treatment subside and life goes back to normal. In some cases there are lasting side effects such as poor bone density, in some cases heart problems, and problems with nerves being affected.

Q13: Will I be tired with radiation treatments?

During radiation therapy the body uses up more energy than it normally does. Most patients feel especially tired during and after their treatments. The key is that you have to learn not to push yourself. You will need more sleep at night, and if you can, nap during the day.

Q14: I have heard that radiation burns your skin. Will this happen to me?

Radiation works much like the effects of the sun leaving the treatment area looking tanned or sunburned. However, many patients have no or only minor skin reactions. More serious reactions include redness, peeling or flaking. The most important thing to remember is to not rub, scrub or scratch the treated area. Keep in mind as well that the affected skin will return to normal a few weeks after treatment is finished.

Q15: Am I destined to have nausea and or vomiting with radiation?

Nausea has been associated with external radiation and generally occurs several hours after treatment. Many patients receiving radiation therapy have reported that the feeling of nausea is eased by having treatment on an empty stomach. Again, medications can be prescribed that can help ease the nausea.

Q16: Will I lose my hair with radiation?

Unlike chemotherapy treatments, hair loss due to radiation only affects the hair in the treated area. Hair loss generally begins in the second week of radiation treatment. In most cases, hair does grow back after treatment is finished.

Q17: What is Lymphoedema?

Lymphoedema (pronounced LIM-FA-DEE-MA) is a medical term that describes the collection of fluid in the arms or legs. The fluid is made up of water and protein. It is not the same as water retention and needs very different care.

Q18: Why is the lymph system important?

Tissue fluid constantly washes in and out of the cells of the body. This fluid brings fuel and food to the cell and takes away waste products. About 90% of this fluid is filtered by a network of tiny blood vessels. The other 10% is made up of large proteins and other particles that are too big to get into the capillaries. The body has a special transport system called the lymphatic system for these large proteins and fluid. It is made up of a series of collecting tubes that get larger and larger until they become ducts that empty into the bloodstream. The fluid called lymph, passes through nodes where harmful bacteria and viruses are removed. You may have felt these nodes in your neck or underarms when you have an infection or illness.

Q19: What causes lymphoedema?

Some people are born with problems in their lymph systems. This is called primary lymphoedema. Other people develop blockages from infections, surgery, cancer, radiation therapy, injury or unknown causes. This is called secondary lymphoedema.

Q20: Can lymphoedema be prevented?

Lymphoedema often develops when the lymph drainage system closest to the treated area is put under stress. It is possible to delay the onset and reduce the amount of lymphoedema by following the recommendations for self care.

Q21: Can lymphoedema be cured?

At this time, it cannot be cured but it can usually be relieved.

Q22: What are the signs of lymphoedema?

You may notice gradual swelling of the hands, arms, feet or legs. It may be very slight for a long time and then become worse. It can also happen years after cancer treatment.
You are not able to wear regular clothes
Muscle aches, pain or a feeling of heaviness in the limb
You may not be able to use the limb normally
If there is a lot of swelling, clear fluid may leak from the skin or the skin may feel like leather and look like the skin of an orange

Q23: Why can cancer treatment lead to lymphoedema?

Most people who undergo surgery for cancer also have some lymph nodes removed and tested for the presence of cancer cells. These tests are necessary because the doctor will plan treatment based on the results of these tests. Unfortunately, removal of these nodes can sometimes prevent the lymph system from draining fluid normally.
Radiation therapy, which kills cancer cells, can cause scar tissue to form in the lymph collecting tubes. Scar tissue blocks the flow of the lymph fluid. One out of every four women who have surgery for breast cancer and two out of every five women who have both surgery and radiation therapy will go on to develop lymphoedema at some point. Some will have hand or arm swelling begin almost immediately after the treatment; others will not have symptoms until years later. Removing lymph nodes from the groin or having radiation therapy to this area can result in swelling of the legs. It is not possible to know who will develop lymphoedema.

Q24: How is lymphoedema treated?

Once the diagnosis of lymphoedema has been made by your doctor, the goal of treatment is to reduce the swelling by moving the lymph fluid to an area where there are working lymph nodes. A combination of methods has been shown to be the most effective:

• Manual lymph drainage: This should be done by a specially trained therapist. The massage is very gentle and different from deep muscle massage. It is usually done every day for 4-6 weeks.
• Special Exercises: Gentle exercise is an important part of keeping the arm and shoulder moving normally. Physiotherapy may be recommended.
• Compression of the limp by using special bandages or an elastic sleeve. If the swelling in the limb is quite large, bandaging may be used to help stop fluid from coming back after massage or physiotherapy is done. Elastic sleeves may also be prescribed by your doctor for the same reason.
• Skin care. Your doctor or nurse will review how you are caring for your skin and make suggestions on ways you can reduce the risk of infection and injury.
• Measurement of the limbs: Your unaffected arm or leg will be measured and compared to the measurements of the affected side. Usually weekly, the affected limb will be measured again to see how well the treatments are working.

Many people ask why the fluid cannot simply drain away. The fluid is located in thousands of tiny pockets similar to the way a sponge holds water. It would not be possible to drain each one.

Q25: What can I do to avoid lymphoedema?

• Keep the affected limb clean and dry. Wash with a gentle soap, pat dry and apply a moisturizing cream.
• Avoid bruises, cuts, burns (including sunburns), insect bites, pet scratches, sprains.
• Don’t cut the cuticles when manicuring the nails on the affected side.
• Avoid using the arm for blood tests, IV’s or blood pressure readings.
• Wear gloves when doing any activity that may cause injury such as housework, gardening or hobbies.
• Use an electric razor to shave underarms or legs.
• Avoid pressure on the shoulder of the affected arm from shoulder bags, backpacks, etc.
• Choose bras that have wide straps.
• Avoid heavy lifting, rubbing, scrubbing, pushing or pulling.
• Avoid any activity that seems to make the swelling worse.
• Avoid tight rings, bracelets, or sleeves that restrict circulation.
• Avoid temperature extremes while bathing, showering or washing dishes. No saunas or hot tubs!!!! If the limb is "achy" do NOT apply heat to relieve the discomfort.
• Elevate the affected arm to shoulder height whenever possible. A compression sleeve should be worn when traveling by airplane.
• Be as active as possible but avoid activities that seem to increase swelling.
• Maintain good nutrition and a healthy body weight.
• Drugs that are called diuretics or "water pills" are not usually helpful.
• Q When to get help?
• An insect bite, pet scratch, rash or blister may lead to a problem. Take care of small wounds by washing them carefully and covering to keep them clean. Any infection should be taken seriously.
• The signs of infection include:
• Increased swelling, often in just one place.
• Redness.
• Tenderness and/or pain.
• Increase in limb temperature.
• Fever and chills unrelated to another illness such as flu.
• If you notice any of these signs, contact your family doctor immediately.